IN THIS ISSUE

Unintended pregnancies and births can bring with them a host of problems for the women involved, their infants and other family members, and society as a whole. And they are unfortunately common events in the United States. Yet, because of data limitations, important aspects of unintended pregnancy and childbearing have been difficult to explore. Three articles in this issue of Perspectives on Sexual and Reproductive Health seek to fill some of the gaps in knowledge, with an eye toward strengthening relevant policy and public health efforts.

Newly available state-level data allowed Lawrence B. Finer and Kathryn Kost to calculate, for the first time ever, the estimated rate of unintended pregnancy for each state and the District of Columbia as of 2006, as well as the proportions of unintended pregnancies that ended in births and abortions (see article). The rates, according to the authors, are a “key indicator” of the reproductive health of women in the states and can serve as “benchmark data to monitor [states’] progress in their efforts to improve women’s reproductive health and reduce rates of unintended pregnancy.”

Emily Monea and Adam Thomas turn to the question of how much U.S. taxpayers spend on medical care for women who have unintended pregnancies and their infants (see article). The sobering answer is an estimated $9.6–12.6 billion annually. And because of certain limitations of the analysis, the researchers point out, that estimate is a conservative one. However, the tab could be cut about in half if all unintended pregnancies were prevented. (It would not be eliminated entirely because some prevented pregnancies would occur later, when they are intended, and would be publicly financed.) In the current fiscal climate, Monea and Thomas write, “the enactment or expansion of policies to prevent unintended pregnancies is a timely and sensible strategy.”

Adam Sonfield and colleagues, meanwhile, use a different approach from Monea and Thomas’s to take both a national and a state-level look at public costs associated with births following unintended pregnancies (see article).They find that public programs pay for a disproportionately high share of such pregnancies, and estimate that public expenditures amount to $11.1 billion per year. The total public expenditure varies widely among states; in two states, it exceeds $1 billion. Given this fiscal burden, the researchers remark, reducing unintended pregnancy not only would improve the lives and health of women and their families, but would enhance “the sustainability of the nation’s health care safety-net programs.”

Also in This Issue

• In qualitative interviews with women who had had emotional difficulties after having an abortion, Katrina Kimport and colleagues found that social processes associated with the experience were important determinants of the emotional burden (see article). Most important, women needed to feel that the decision to terminate a pregnancy was primarily their own, and to know that they would have the emotional support of their partners, family and close friends after the abortion. Gender-based imbalances in couples’ division of responsibility related to contraception, abortion and childrearing also played a role. Thus, the investigators argue that minimizing women’s postabortion emotional difficulties requires “changing social behaviors, rather than clearing procedural hurdles.”

• Teenagers who engage in risky sexual behavior may become young adults who experience negative reproductive health outcomes, according to a report by Mindy E. Scott and colleagues (see article). Using data from the National Longitudinal Study of Adolescent Health, the researchers find a positive association between cumulative risk during adolescence and all three outcomes assessed during young adulthood: multiple partnerships within the past year, an STD history and involvement in an unintended birth. The associations appear to be additive, but the link between individual risk behaviors and outcomes varies. Thus, in the authors’ view, interventions that address multiple domains of risk may be the most effective in addressing young people’s reproductive health needs.

• Looking at another dimension of young adults’ reproductive health, Jennifer Manlove and coauthors show that characteristics of a relationship may predict couples’ contraceptive use (see article). For example, in their study’s sample of 18–26-year-old participants in the National Longitudinal Survey of Youth, the likelihood that a couple had used any method at last sex was positively associated with the reported level of intimacy and negatively associated with the reported level of conflict within their relationship. Manlove and colleagues conclude that whereas many programs aimed at preventing unintended pregnancy and STDs take “an individual, knowledge-based approach,” interventions should also consider the context of young people’s relationships and provide models of “healthy relationships.”